The continuity version

The 'continuity' version states that for centuries 'insanity' and 'madness' referred to a melee of mental diseases which physicians were unable to separate. In the 1850s, Morel coined the term démence précoce to refer to states of cognitive deficit in adolescence. During the second half of the nineteenth century, 'catatonia' was described by Kahlbaum and 'hebephrenia' by Hecker. At the end of the century, Kraepelin realized that both disorders, together with 'dementia paranoides' (which he had himself discovered), were manifestations of the same disease process. Kraepelin called this disease dementia praecox and based it on empirical data kept in follow-up cards. In 1911, Bleuler renamed it 'schizophrenia' and, during the 1930s, Schneider listed diagnostic criteria which, owing to their 'empirical' and 'atheoretical' character, deserved to be enshrined in DSM-IV.

It is also part of the continuity story that European psychiatry was influenced by Kraepelin, while American psychiatry followed Adolph Meyer, Bleuler, and the psychoanalysts^,,5 and 6) (although Manfred Bleuler, in an interesting paper approved by his father, wrote: (7) 'Since coming to the United States I have had the valuable experience of realizing that the conceptions of schizophrenia are very different here from those held in our clinic at Burgholzli'). This would explain the confused definitions offered in DSM-I and DSM-II(7) and the diagnostic disparities found between the United Kingdom and the United States (of course, this view does not explain the major differences in the conception of schizophrenia between Germany, Italy, France, Russia, Norway, the United Kingdom, etc.). In the event, Kraepelin and Schneider were discovered in the United States, psychoanalysis was eased out, and this paved the way for the advent of biological psychiatry. After some uncertainties (e.g. DSM-III), DSM-IV now offers the de facto official definition of schizophrenia.

The problem with this version of events is that it occurs in a historical vacuum. Neither the alternative definitions of schizophrenia nor the factors that explain the successful views are ever mentioned; indeed, the impression is given that there has been an ineluctable progress towards 'the truth'. However, this flattering narrative is hollow for, given that the current definition of schizophrenia is still made on phenomenological grounds, it is necessary to ask how to decide which of the historical definitions were right and which were wrong.